偏头痛患者在脑缺血期间易发生梗死。
Vulnerability to Infarction During Cerebral Ischemia in Migraine Sufferers.
机构信息
From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.).
出版信息
Stroke. 2018 Mar;49(3):573-578. doi: 10.1161/STROKEAHA.118.020554. Epub 2018 Feb 19.
BACKGROUND AND PURPOSE
Cerebral hyperexcitability in migraine experiencers might sensitize brain tissue to ischemia. We investigated whether a personal history of migraine is associated with vulnerability to brain ischemia in humans.
METHODS
Multicenter cohort study of patients with acute ischemic stroke who underwent a brain computed tomography perfusion and were scheduled to undergo reperfusion therapy. In a case-control design, we compared the proportion of subjects with no-mismatch, the volume of penumbra salvaged, as well as the final infarct size in a group of patients with migraine and a group of patients with no history of migraine.
RESULTS
We included 61 patients with migraine (34 [55.7%] men; mean age, 52.2±15.1 years; migraine without aura/migraine with aura, 44/17) and 61 patients with no history of migraine. The proportion of no-mismatch among migraineurs was significantly higher than among nonmigraineurs (17 [27.9%] versus 7 [11.5%]; =0.039) and was more prominent among patients with migraine with aura (6 [35.3%]; =0.030) while it was nonsignificantly increased in patients with migraine without aura (11 [25.0%]; =0.114). Migraine, especially migraine with aura, was independently associated with a no-mismatch pattern (odds ratio, 2.65; 95% CI, 0.95-7.41 for migraine; odds ratio, 5.54; 95% CI, 1.28-23.99 for migraine with aura), and there was a linear decrease of the proportion of patients with migraine with aura with increasing quartiles of mismatch volumes. Patients with migraine with aura had also smaller volumes of salvaged penumbra (9.8±41.2 mL) compared with patients with migraine without aura (36.4±54.1 mL) and patients with no migraine (45.1±55.0 mL; =0.056). Conversely, there was no difference in final infarct size among the 3 migraine subgroups (=0.312).
CONCLUSIONS
Migraine is likely to increase individual vulnerability to ischemic stroke during the process of acute brain ischemia and might represent, therefore, a potential new therapeutic target against occurrence and progression of the ischemic damage.
背景与目的
偏头痛患者的大脑过度兴奋可能使脑组织对缺血敏感。我们研究了偏头痛病史是否与人类脑缺血易感性相关。
方法
这是一项多中心队列研究，纳入了接受急性缺血性脑卒中脑 CT 灌注检查并计划接受再灌注治疗的患者。采用病例对照设计，我们比较了偏头痛组和无偏头痛组患者的无错配比例、挽救的半暗带体积以及最终梗死体积。
结果
我们纳入了 61 例偏头痛患者（34 例男性，平均年龄 52.2±15.1 岁，无先兆偏头痛/有先兆偏头痛 44/17 例）和 61 例无偏头痛病史患者。偏头痛患者的无错配比例明显高于无偏头痛患者（17 [27.9%] vs. 7 [11.5%]；=0.039），且有先兆偏头痛患者的无错配比例更显著（6 [35.3%]；=0.030），而无先兆偏头痛患者的无错配比例虽略有增加，但无统计学意义（11 [25.0%]；=0.114）。偏头痛，尤其是有先兆偏头痛，与无错配模式独立相关（优势比 2.65；95%置信区间 0.95-7.41，用于偏头痛；优势比 5.54；95%置信区间 1.28-23.99，用于有先兆偏头痛），且随着错配体积四分位间距的增加，有先兆偏头痛患者的比例呈线性下降。有先兆偏头痛患者的挽救半暗带体积也较小（9.8±41.2 mL），低于无先兆偏头痛患者（36.4±54.1 mL）和无偏头痛患者（45.1±55.0 mL；=0.056）。相反，3 个偏头痛亚组之间的最终梗死体积无差异（=0.312）。
结论
偏头痛可能增加急性脑缺血过程中个体对缺血性脑卒中的易感性，因此可能成为预防缺血性损伤发生和进展的潜在新治疗靶点。
Zotero 插件